Treating Breast Cancer Recurrence A Complex Decision
The outcome and treatment of local recurrence of breast cancer in women depends more on a patient's menopause status and the clinical and tumor characteristics of the initial tumor than on other factors.
The findings of a study published in the June 1 print issue of CANCER and now available online via Wiley InterScience, indicate that the risk of death significantly increased in women with local recurrence of breast cancer when the initial tumor was greater than grade 2, the time interval without cancer was less than eight years, and the age at diagnosis of the primary tumor was greater than 60 years.
The type of surgery for the initial, primary breast cancer did not alter mortality risk. While no specific treatment altered the risk of death after local recurrence in postmenopausal women, premenopausal women benefited from treatment with either surgical or irradiative ovarian suppression or chemotherapy.
Women with a single, local recurrence were more likely to survive 10 years than women presenting with distant metastatic recurrence.
While studies demonstrate that breast-conserving surgery followed by local irradiation did not modify overall survival compared to radical or modified mastectomy alone, they do suggest a decreased recurrence rate.
Recent studies have suggested the type of initial therapy does not alter survival after a local recurrence.
However, limitations in study design made analysis for prognostic relevance less than comprehensive.
Lê et al analyzed data from patients with early breast cancer who experienced a single, isolated local recurrence. They identified factors that potentially altered the risk of death, including initial tumor and patient characteristics, type of treatment of initial breast cancer and recurrence.
The authors retrospectively reviewed records of 1636 patients with early-stage breast cancer that was treated surgically with either breast-conserving surgery or mastectomy and identified two cohorts.
The authors analyzed data from 105 patients at the Institut Gustave Roussy in Villejuif, France, who experienced an isolated, local recurrence of cancer to determine the relationship between clinical and tumor characteristics and the risk of death after recurrence.
The authors identified seven potential factors: initial size of primary tumor, tumor grade by pathology, axillary lymph node status, date of initial diagnosis, age at diagnosis, time interval without cancer recurrence and the type of treatment for initial and local recurrence.
The authors further identified a second subgroup of 335 patients who developed distant metastases as the first recurrence. Data from these two subgroups was analyzed for survival.
Analysis of data from the 105 patients with local recurrence indicate that only tumor grade, age at diagnosis of the primary tumor and the time interval without tumor recurrence altered the risk of death.
Patients with a grade 3 tumor had a three-fold increased risk of death. Patients over 60 years old at the time of diagnosis of the primary cancer had a two-fold increased risk of death.
Patients who experienced over eight years without recurrent tumor had a three-fold decreased risk of death.
Significantly, the risk of death after a local recurrence was independent of whether or not the patient's primary cancer was treated with breast-conserving surgery or mastectomy.
However, the type of treatment of a local recurrence altered the mortality risk -- but only in women of premenopausal age.
Ovarian suppression by either surgical removal of the ovaries or pelvic irradiation and chemotherapy significantly reduced the risk of death, with relative risk values of 0.2 for each category.
Neither breast surgery nor radiation nor tamoxifen was associated with statistically significant alterations in the risk of death.
Women with a local recurrence of tumor were more likely to survive 10 years than women with a distant metastasis; the 10-year survival rates were 56% and 9%, respectively. The median survival for women with local recurrence was 12.9 years compared to 2.2 years for women with a distant metastasis.
"Because an isolated recurrence carries a relatively good prognosis," the authors write, patients have potentially more treatment options. That is, "mastectomy does not appear to be mandatory" for local recurrence after the patient has undergone breast-conserving surgery for the initial tumor.
The authors add, "local radiotherapy may be indicated in patients who previously underwent mastectomy" and "the use of chemotherapy at the time of recurrence in premenopausal patients" may be appropriate. "Analyses like those performed in this retrospective series may put forward hypotheses that can be evaluated prospectively," the authors conclude.
(Reference: "Prognostic Factors for Death After an Isolated Local Recurrence in Patients with Early-Stage Breast Carcinoma," Monique G. Lê, Rodrigo Arriagada, Marc Spielmann, Jean-Marc Guinebretiére, France Rochard, CANCER; June 1, 2002; 94:11; pp. 2813-2820.)
CANCER is an Interdisciplinary International Journal of the American Cancer Society. The print and online versions of the journal are published by John Wiley & Sons, Inc.
Thanks to Daily University Science News.
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